ANGIOMAX Mode of Action

Angiomax® (bivalirudin) directly inhibits thrombin and thrombin mediated platelet activation.

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Angiomax® (bivalirudin) Precision Targets Thrombin Directly

ANGIOMAX Benefits Avoid the Risk and Limitations of Heparin

  • Can be utilized as monotherapy for patients undergoing PCI3-5*
  • Enables fast-on, fast-off activity1
  • No need for continuous aPTT or ACT monitoring1

* In REPLACE-2: 93% of ANGIOMAX patients received ANGIOMAX monotherapy3;
in the ACUITY ANGIOMAX-ALONE group: 91% of PCI patients received ANGIOMAX monotherapy4;
in HORIZONS AMI: 93% of ANGIOMAX patients received ANGIOMAX monotherapy.5

ANGIOMAX is more effective against clot-bound thrombin than heparin

  • Even at a low concentration, ANGIOMAX effectively inhibits both clot-bound and soluble thrombin6,7*

Adapted from Weitz JI et al. J Clin Invest. 1990;86:385-388.

Clot-bound thrombin is an important source of clot extension and propagation of thrombin production6,7

* In an in vitro study.

ANGIOMAX does not activate platelets8,9

  • ANGIOMAX inhibits thrombin-mediated platelet activation8
  • Activated platelets secrete platelet factor 4 (PF4), which can neutralize heparin9

ANGIOMAX inhibits platelets via thrombin

  • Platelet inhibition occurs well below therapeutic levels of ANGIOMAX9

Adapted from Weitz J et al. Am J Cardiol. 2001;88(5 suppl 1):83G.

ANGIOMAX overcomes the risks and limitations of heparin

‡ Sheath removal has not been studied in dialysis-dependent patients treated with ANGIOMAX. Follow standard hospital protocol for this population.1

HIT=heparin-induced thrombocytopenia; HITTS= heparin-induced thrombocytopenia and thrombosis syndrome; IV=intravenous; ACT = activated clotting time

Safety Considerations
ANGIOMAX with provisional use of glycoprotein IIb/IIIa inhibitor is indicated for use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI), and in patients with or at risk for heparin-induced thrombocytopenia and thrombosis syndrome (HIT/HITTS) undergoing PCI. ANGIOMAX is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin. ANGIOMAX is contraindicated in patients with active major bleeding or hypersensitivity to ANGIOMAX or its components. The most common (≥10%) adverse events for ANGIOMAX were back pain, pain, nausea, headache, and hypotension. An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic event and cessation of ANGIOMAX administration. Please see complete prescribing information.

1ANGIOMAX Prescribing Information. The Medicines Company; Parsippany, NJ, December 6, 2005.

2Bates SM, Weitz JI. The mechanism of action of thrombin inhibitors. J Invas Cardiol. 2000;12(suppl F):1F-12F.

3Lincoff AM, Bittl JA, Harrington RA, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial.JAMA. 2003;289:853-863.

4Stone GW, White HD, Ohman EM, et al; for the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial investigators. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention. Lancet. 2007;369:907-919.

5Stone GW, Witzenbichler B, Guagliumi G, et al; for the HORIZONS AMI trial investigators. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358:2218-2230.

6Weitz JI, Hudoba M, Messel D, Maraganore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors. J Clin Invest. 1990;86:385-391.

7Data on file. The Medicines Company; Parsippany, NJ.

8Fritsma GA. Direct thrombin inhibitors. Clin Lab Sci. 2004;17:118-123.

9Weitz J, Maraganore J. The thrombin-specific anticoagulant, bivalirudin, completely inhibits thrombin-mediated platelet aggregation. (abstract TCT-212). Am J Cardiol. 2001;88(5 suppl 1):83G.

10Mehta S, Yebara SM, Ibrahim M, et al. Cedars Medical Center’s experience: early ambulation post PCI with use of direct thrombin inhibitor, bivalirudin. Cath Lab Digest. 2004;12:1-4.

11Minutello RM, Wong SC, Chou ET, et al. Angiomax facilitates early sheath removal after coronary angioplasty: the AFRICA Study. (abstract 340). Presented at: 15th Transcatheter Cardiovascular Therapeutics Meeting;
Washington, DC; 2003.

12Schussler JM, Cameron CS, Anwar A, et al. Effect of bivalirudin on length of stay in the recovery area after percutaneous coronary intervention compared with heparin alone, heparin + abciximab, or heparin + eptifibatide. Am J Cardiol. 2004;94:1417-1419.

13Xiao Z, Theroux P. Platelet activation with unfractionated heparin at therapeutic concentrations and comparisons with a low-molecular-weight heparin and with a direct thrombin inhibitor. Circulation. 1998;97:251-256.